Charles

*Update

I spoke to Adult Protective Services about this patient. They told me they are aware of his plight but can’t do anything because he receives a pension that prevents him from qualifying for public assistance. That is partially true, his wife receives the money at their home but it is not enough to get him the medical help he needs. Adult Protective Services told his wife to divorce him as soon as possible and make sure he received nothing in the divorce, then they could help him.

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Last year I had a 64 year old male patient who was living in the nursing home and doing well. He was a complicated patient with many major disease processes confounding his life. He was discharged to his home against the wishes of the medical staff because he did not qualify for welfare as a payor source for his room and board.

Charles was living at home with his wife and doing poorly. He has diabetes very poorly controlled because his eyesight is so poor he can’t read the label on his insulin or the syringe. His insurance company refused to pay for a talking syringe because he was not yet blind enough. As is usual for an uncontrolled diabetic he also has poorly functioning kidneys. At some point he developed a psychiatric disorder and his wife kicked him out of the house and he ended up living on the street.

He did not last long living on the street before he went into acute kidney failure and ended up in the hospital near death. His wife decided that she could not watch him suffer like this and allowed him to come home after the good doctors at the hospital got all his medical conditions straitened out, except one. Shortly after he was discharged he became psychotic once again and chased his wife around the house with a knife in his hand and threatened to kill her.

After another trip to the hospital and the introduction of an antipsychotic medication he was pleasant and manageable. This time however he was discharged to a long term care facility (Nursing home) and that is where he became a patient of mine. The new antipsychotic he was started on really changed his life and he assisted the activities manager to open a small store at the nursing home. Charles spent hours everyday stocking and managing the store and really felt good that he was able to provide this service to the other residents.

And everyone live happily ever after…

I wish that were the case. You see, Charles was only 64 years old and had not yet applied for Medicare. He did qualify for Medicaid (called Arizona Healthcare Cost Containment System, AHCCCS in Arizona, cough cough).

Charles applied for ALTCS, a Medicaid funded County insurance that pays for room and board. Even though Charles was nearly blind, diabetic, hypertensive, anemic, had chronic renal failure and episodes of acute renal failure, psychotic breaks, and atherosclerotic heart disease he did not qualify for ALTCS. Did I mention Charles worked his entire life and paid taxes and protected us from bad people?

Though he had medical coverage he did not have a payor source for his room and board. And while he had worked his whole life as a Policeman and retired from the Police Force there was no way his wife could afford the room and board for Charles and still pay for the house and the other bills. Charles was kicked out of the nursing home and sent back to his home. He was still unable to see and because of this I knew he was not going to be able to administer his medications properly. His wife has had several strokes and is unable to assist him with his medications.

Charles was recently admitted to a local hospital for out of control diabetes and psychotic mood disorder. Seems neither he nor his wife were able to manage his complex medical regime at home. I was told the hospital tried to discharge him home but his wife refused so they discharged him to the homeless shelter. What the hell is that? A man worked an honorable job his entire life and society literally throws him to the streets. I spoke with our case manager and she is trying to track Charles down and get him enrolled in an insurance plan that will pay for his nursing home room and board. It angers me to no end that I have illegal alien patients on the public dole with less problems than Charles living in our nursing homes. I told the case manager I was going to find Charles, tell him to respond to all questions with No habla English, and tell everyone his name is Julio Rodriguez. This would be funny if Charles was not living on the streets and facing death from diabetic ketoacidosis or hypoglycemia.